Is White rice the culprit for the expanding waist line in South Indians?

Abstract

Increasing prevalence of overweight and obesity in India has a direct association with the rising prevalence of obesity-related co-morbidities. Dietary factors are correlated with overweight and obesity; therefore, dietary intervention could be a target for obesity prevention. Objective: To assess the nutritional status of the diabetic population and to evaluate if white rice is contributing to the high prevalence of abdominal obesity, general obesity in the study group. Whether Waist Circumference (WC) and Waist Hip Ratio(WHR) are better indices for measuring obesity than Body mass Index(BMI) Methods: An observational study was done in a total of 23417 diabetics (9183 women, 14234 men) between the age group of 25-98 years. Body weight, height, waist and hip circumference were measured and recorded using standard measuring instruments. Classification of obesity was done using World Health Organisation (WHO) and International Diabetes Federation (IDF) criteria for BMI in Asians, while WC and WHR according to IDF criteria. Nutritional status of 3750 patients was assessed based on 24 hour dietary recall, accounting for the amount of carbohydrates, proteins and fat intake. Also the number of servings of vegetables and fruits were recorded. Results: Prevalence of overweight and obese according to BMI (WHO) is 85% in women and 74% in men. WHR identified 89% of men with abdominal obesity compared to 76% of women. The waist circumference among men and women according to the IDF criteria 65% men (n=9235) and 89 % women (n=8175) have a WC above the normal. This proves that WHR and WC are better indices than BMI in identifying people with abdominal obesity and high risk for cardiovascular morbidity. The age incidence of diabetes was similar in both men and women. Major calories are derived from carbohydrates up to the extent of 80% of which 50% is derived from white rice thus contributing to the higher prevalence of both abdominal and general obesity. In people with abnormal WC they were consuming 300-400 calories derived from white rice. The high caloric white rice adds to the burden of abdominal obesity and general obesity. 52 % were consuming higher than 2000k calories of their daily intake. The protein consumption is only 8.5% of the total calories and this clearly indicates that there is protein deficiency in the population. 63% consumed less than 2 servings of vegetables against the recommended 3-4 servings. And 66% did not consume any fruits at all. The mean protein intake in the population is 8.53% against the recommended 20-30%. Conclusion: High intake of carbohydrate rich diet, with major contribution from the white rice, low fibre, and low protein, inadequate intake of fruits and vegetables, lack of adequate physical activity is contributing to very high prevalence of abdominal obesity and general obesity. WC and WHR are better indices in defining obesity in the population. We need to change the practice of consumption of white rice to a healthy option of unpolished rice or brown rice, with whole grains and adequate fruits and vegetables.